In psychiatric patients, medication adverse effects are regularly attributed to psychosomatic causes. However, many psychotropic medications are metabolized by cytochrome P450 (CYP450) enzymes. In the setting of polypharmacy, the activity of these enzymes may produce unfavorable drug-drug interactions (DDI) and drug-genotype interactions (DGI) that contribute to morbidity and mortality. This study sought to estimate the risk of adverse DDI and DGI in psychiatric inpatients with polypharmacy. We assessed whether medication changes made after pharmacogenetics (PGx) testing correlated with changes in side effects and overall improvement. Adult psychiatry inpatients with polypharmacy, defined as 5 or more scheduled prescription medications, completed the 24-item Antidepressant Side Effect Checklist (ASEC) questionnaire on enrollment and underwent PGx testing. Analysis of PGx results focused on whether the CYP2D6 and CYP2C19 phenotypes were "extreme," defined as poor, poor to intermediate, or ultrarapid. Approximately 30 days after PGx results were sent to outpatient providers, patients were contacted to obtain their current medication list and ASEC and Clinical Global Impression Improvement (CGI-I) scores. A total of 80 patients were enrolled, and 52 (65%) completed follow-up. ASEC scores improved from 11.5 (±8.1) to 7.2 (±6.0) (p = 0.0009). Mean CGI-I score was 2.7 (±1.4), between "minimal" to "much improved." However, linear regression revealed that these improvements were not correlated with whether medications were changed. We concluded that the impact of drug-genotype interactions in this small sample of inpatients with polypharmacy was low, and that patient improvement was related not to PGx-guided medication changes but to other treatments during hospitalization.

中文翻译：

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多药治疗精神病住院患者的药物遗传学检测与药物副作用减少有关，但与药物变化无关。

在精神病患者中，药物不良反应通常归因于心身原因。然而，许多精神药物是由细胞色素 P450 (CYP450) 酶代谢的。在多药治疗的情况下，这些酶的活性可能会产生不利的药物-药物相互作用 (DDI) 和药物-基因型相互作用 (DGI)，从而导致发病率和死亡率。本研究旨在评估使用多种药物治疗的精神病住院患者发生不良 DDI 和 DGI 的风险。我们评估了药物遗传学 (PGx) 测试后的药物变化是否与副作用变化和整体改善相关。使用多种药物的成人精神病住院患者，定义为 5 种或更多预定处方药，完成了 24 项抗抑郁药副作用清单 (ASEC) 调查问卷，并接受了 PGx 测试。PGx 结果分析的重点是 CYP2D6 和 CYP2C19 表型是否“极端”，定义为差、差到中等或超快。在将 PGx 结果发送给门诊提供者大约 30 天后，我们联系了患者以获取他们当前的药物清单以及 ASEC 和临床整体印象改善 (CGI-I) 评分。共有 80 名患者入组，52 名（65%）完成了随访。ASEC 分数从 11.5 (±8.1) 提高到 7.2 (±6.0) (p = 0.0009)。平均 CGI-I 得分为 2.7 (±1.4)，介于“最小”到“显着改善”之间。然而，线性回归显示这些改善与是否改变药物无关。